Provision of anaesthesia services for emergency obstetric care through task shifting in South Asia

Abstract

Anaesthesia is required for certain procedures in emergency obstetric care, such as caesarean section and the repair of ruptured uterus. Task shifting for provision of anaesthesia has been implemented in public sector rural hospitals of South Asia in recent years because of significant shortages of anaesthetists, but there has been limited research on this issue. This paper reviews the literature on this topic and documents existing programmes for task shifting anaesthesia services to mid-level providers in South Asia to increase access to emergency obstetric care and reduce maternal mortality. We found that task shifting of anaesthesia services has been effective in expanding coverage and access to care in South Asia, but most programmes have not been implemented systematically as part of an overall human resources strategy. A comprehensive approach, to maximise the benefits of these programmes, calls for countries to appoint a director at national or state level who is responsible for the availability of anaesthesia services in rural areas; legal protections, licensing by a competent authority and registration to perform anaesthesia services, including prescription of anaesthesia drugs; supportive managerial arrangements, competency-based training, monitoring and evaluation; performance rewards, career structure and job clarity; adequate equipment and supplies; support from specialist anaesthetists and quality assurance for safety.

Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care?

“…4 Increasing evidence is beginning to emerge that maternal and infant survival is proportionately correlated to the number of health workers providing obstetric care that includes anaesthesia. 5,6 The delivery of surgical (including obstetrics and trauma) care is highly dependent on the availability and retention of a trained anaesthesia health workforce. The United Kingdom Confidential Enquiry for Perioperative Death in 1987 reported one death per 185 000 anaesthetic procedures; whereas in Zambia (University teaching hospital), it was one death per 1925.…”

“…While in some developing countries such as India, there are a large number of physician anaesthetists in the cities, they are generally scarce or even non-existent in remote and rural areas. In Afghanistan (population of 32 million), there are only 9 physician anaesthetists, only 8 in Bhutan (population less than 700 000), 5 and 13 (excluding expatriates) in Uganda (population of 27 million) . 8 In comparison, in the United Kingdom of Great Britain and Northern Ireland there are 12 000 physician anaesthetists for a population of 64 million.…”

“…In Sri Lanka, it is estimated that more than 30% of Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? 5 In other countries, such as India, regulations and policies prevent non-physicians from providing much-needed anaesthesia services.…”

“…Many countries such as Bangladesh, Bhutan, India, Nepal and Sri Lanka have initiated task-shifting programmes to increase their capacity in providing anaesthesia and life-saving services, and this has resulted in an increase in the number of surgeries performed (Nepal). 5 Such programmes should aim to provide basic anaesthesia skills for emergency and essential surgical procedures required at first referral level facilities, with more extensive training to dedicated non-physician anaesthetists at secondary level facilities, where there are often no physician anaesthetists. These trained non-physician anaesthetists would also support physician-anaesthetists in secondary and tertiary facilities where their numbers are insufficient.…”

Activism: working to reduce maternal mortality through civil society and health professional alliances in sub-Saharan Africa

“…Training non-physician clinicians as well as medical and nursing staff to provide better quality obstetric care is a way of increasing the number of skilled staff available, to prevent cases escalating to emergencies, and to respond swiftly when they do, improving outcomes. 30,31 Surgical and anaesthetic skills contribute significantly to reductions in maternal and child mortality but are in short supply in Africa. [32][33][34] For health facilities to manage obstetric emergencies correctly they need well-trained, well-supervised, skilled and equipped staff.…”